Enteral nutrition: A first option for nutritional support of children following allo-SCT

Hématologie pédiatrique, Hôpital Jeanne de Flandre, Univ Lille Nord de France, Lille, France.
Bone marrow transplantation (Impact Factor: 3.57). 01/2012; 47(9):1191-5. DOI: 10.1038/bmt.2011.248
Source: PubMed


Parenteral nutrition (PN) is the treatment of choice for nutritional support of patients undergoing allo-SCT following myeloablative conditioning (MAC). Here we prospectively assessed the outcomes of early enteral nutrition (EN) in a paediatric cohort. From 2003 to 2010, all 65 consecutive children undergoing MAC allo-SCT at our referral centre began EN the day after transplantation. Post-transplant and nutritional outcomes of patients receiving only EN (EN group, n=50) were compared with those of patients requiring additional PN (EN-PN group, n=15). In the EN group time to platelet recovery (P=0.01) and length of hospitalisation (P<0.001) were shorter, while in the EN-PN group the proportion of unrelated donors (P=0.02) and the frequency of severe acute GVHD (aGVHD; P=0.004) were higher. All patients were alive at day 100. PN was started 14 days after transplant because of poor digestive tolerance to EN or severe gut aGVHD. The body mass index Z-score in the EN-PN group decreased from transplant to discharge (P=0.02). In only 23% of cases was PN required for severely ill patients. Our results suggest that EN might be considered to be an option for nutritional support in children undergoing MAC allo-SCT, while PN should be used only as a rescue option, possibly in combination with EN.

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    • "Niemniej pojawiły się także badania przeczące złej tolerancji EN po allo-HSCT poprzedzonym mieloablacyjnym kondycjonowaniem , a stwierdzające znamienne korzyści kliniczne z takiej formy NS – poprawę w zakresie 100- -dniowego przeżycia, skrócenie czasu regeneracji granulocytów obojetnochłonnych i protekcyjne działanie w stosunku do występowania aGvHD [15] oraz,, szybszą regenerację płytek i krótszy czas hospitalizacji [16]. Jednak w pierwszym z cytowanych badań porównywano pacjentów otrzymujących EN (lub EN + następnie żywienie pozajelitowe – PN; parenteral nutrition) z pacjentami otrzymującymi PN lub nieotrzymującymi żadnej formy NS, zaś drugie badanie dotyczyło populacji dziecięcej i porównywano w nim EN vs EN+PN. "
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    ABSTRACT: Hematopoietic stem cell transplantation (HSCT) – the highly aggressive therapeutic process – is connected with high risk of side effects and complications, which influence nutritional management. Moreover, limitation of possibility of nutrients delivery is accompanied by simultaneous increase in requirement for nutritional elements. Thus, implementation of nutritional support as an element of supportive treatment is advisable or necessary in many of these patients. Unfortunately, there is a lack of uniform clinical nutrition guidelines for HSCT patients. Currently, special attention is paid to: suitable qualification for different form of nutritional support, consideration of routine implementation of nutritional support after myeloablative conditioning (especially with total body irradiation), avoidance of unjustified arrest of oral/enteral nutrition (probably higher risk of Graft-vs-Host disease – GvHD) and likely clinical advantages of the use of glutamine and/or omega-3 fatty acids in nutritional mixtures. Moreover, in the context of clinical nutrition, patients with severe gastro-intestinal toxicity and persons with GvHD grade > II with intestinal failure require special attention. For these patients, primary nutritional support is parenteral nutrition (PN). The indications of PN implementation include: impossible, ineffective (e.g. nutrients absorption <50% daily requirements) or contraindicated oral/enteral feeding and progressive undernutrition. In case of use of myeloablative conditioning with total body irradiation and high-dose chemotherapy, the routine PN initiation should be taken into consideration according to preemptive strategy. Composition of intravenous nutritional mixtures is also very important. Based on scientific references and own study, the addition of glutamine and omega-3 fatty acids seems to be advisable (e.g. positive influence of mucous membrane regeneration and hematopoietic recovery, less complications). However, not all clinical studies confirmed above mentioned advantages. Moreover, optimal daily dose of these substrates is currently unknown.
    Preview · Article · Jul 2013 · Acta haematologica Polonica
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    ABSTRACT: We aimed to demonstrate whether enteral nutrition (EN) is feasible in daily practice of hematopoietic stem cell transplantation (HSCT).Nutritional records of 100 patients were evaluated. Patients with poor oral intake were fed by EN with tube. A total of 79 patients required nutritional support. Of them, 71 were fed by EN only. Five were fed by EN plus parenteral nutrition (PN),three were fed by PN only. Median duration of EN was 21 days. In the EN only group, 68% gained or maintained their weight. EN should be considered as a feasible option for nutrition support in children undergoing HSCT. Pediatr Blood Cancer 2012; 59: 1327-1329. © 2012 Wiley Periodicals, Inc.
    No preview · Article · Dec 2012 · Pediatric Blood & Cancer
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    ABSTRACT: Allogeneic haematopoietic stem-cell transplantation (allo-HSCT) is associated with frequent and severe malnutrition, which may contribute to transplant-related morbidity. While both enteral nutrition (EN) via a nasogastric tube and parenteral nutrition (PN) are effective, it remains unclear what is the optimal method of nutritional support. We propose to compare the impact of EN versus PN on early outcome after allo-HSCT. We evaluated the effect of initial nutritional support with EN versus PN on early outcome in 56 patients who required nutritional support after first allo-HSCT for haematological malignancies in our centre. Patients were offered EN but could decline and chose to be treated by PN. Twenty patients received myeloablative conditioning and 36 received reduced-intensity conditioning. Twenty-eight patients received EN and 28 received PN. Compared with PN, EN was associated with a lower median duration of fever (2 versus 5 days; p < 0.01), a reduced need for empirical antifungal therapy (7 versus 17 patients; p < 0.01), a lower rate of central venous catheter replacement (9 versus 3 patients; p = 0.051) and a lower rate of transfer to intensive care (2 versus 8 patients; p = 0.036). The early death rate (<100 days) was the same in both groups (14%). Compared with PN, EN was associated with a lower risk of infection in allo-HSCT, without an increase in the incidence of graft-versus-host disease.
    Full-text · Article · Jul 2013 · Clinical nutrition (Edinburgh, Scotland)
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